The Ethics of Organ Transplants: The Current Debate

19. Families' Self-Interest
and the Cadaver's Organs:
What Price Consent?

Edmund D. Pellegrino

It is tragic for an eligible recipient to die for want of a lifesaving organ. The
profession and society are under a clear moral compulsion to seek ways to
prevent such deaths. But it would be equally tragic, even in order to save
lives, to resort to such a morally dubious and destructive policy to increase
the supply of donated organs as Peters suggests. His proposal that a $1000
death "benefit" be offered to motivate families to consent to removal of
organs from their deceased relatives is logically, ethically, and practically
flawed.

In his sincere and understandable commitment to save lives, Peters follows an oversimplified line of reasoning: people die waiting for organ transplants. Organs are scarce because we have relied on altruism to motivate
donors. Therefore, self-interest must replace altruism as a motive. With the
obstacle of activism out of the way, Peters believes that an adequate supply,
and even a surplus, of organs can be expected; that minority groups would
benefit; that the "coercion" he sees in our reliance on altruism would be eliminated; and that altruism itself would be preserved.

Peters' argument is based on a faulty interpretation of altruism. Altruism
is not a value imposed on donor families. No one can be coerced into altruism
because altruism requires a free and conscious recognition of other persons
in the way we conduct ourselves.
1,2 It is a fundamental virtue of, good societies and good persons. It is not valid only in a context of plenty. Physicians
are not free unilaterally to eliminate altruism from decisions to donate
organs. To create a deliberate conflict between altruism and self-interest is to
reduce our freedom to make a gift to a stranger.
3 This, as Titmuss3(pp12-13) shows

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Originally published in JAMA 265, no. 10 ( March 13, 1991): 1305-1306.

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